Rath, Rita NEW YORK STATE DEPARTMENT OF HEALTH4 4
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Vital Records Section BUrla� - Transit Permit
Name First Middle Last Sex
RITA MAHON RATH FEMALE
Date of Death Age If Veteran of U.S.Armed Forces,
04/24/2016 76 War or Dates
f— Place of Death Hospital, Institution
Z City ,Town or Village City of Albany or Street Address ALBANY MEDICAL CENTER
W Manner of Death Natural Undetermined Pending
® El Accident ❑ Homicide ❑ Suicide ❑ ❑
W Cause Circumstances Investigation
ill Medical Certifier Name Title
C) MATTHEW SCHEIDLER MD
Address
43 NEW SCOTLAND AVE., ALBANY NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 893
Date Cemetery or Crematory
❑ Burial 4/26/2016 PINE VIEW CREMATORIUM
❑ Entombment Address
® Cremation QUEENSBURY, NY
Date Place Removed
Z Removal and/or Held
0 ❑ and/or Address
F_ Hold
N
O Date Point of
a. Transportation Shipment
co ❑ By Common De tination
CI Carrier
❑ Disinterment Date Cemetery Address
Date Cemetery Address
❑ Reinterment
Permit Issued To Registration Number
Name of Funeral Home REGAN DENNY STAFFORD FH 01143
Address
53 QUAKER RD QUEENSBURY, NY 12804
Name of Funeral Firm Making Disposition or to Whom
▪ Remains are Shipped, If Other than Above
Address
LU /� r,-,
a. Permission is hereby granted to dispose of the human remains describ ab ve as i di ted. 1 af<
w �./
Date 04/26/2016 Registrar of Vital Statistics
Issued (signature)
District Number 101 Place City of Albany, NY
I certify that the remains ofthe
decedent identified above were disposed of in accorda ce with this permit on:
Date of Disposition J 1 ZI �L Place of Disposition Rik/ 04/frOvta'�
w (address)
to
c` (section) Aot number) (grave number)
0 0 ki�7 SDI
w Name of Sexton or Person in Charge of Premises
(please print) flit
Signature ee Title titre.
�y e.
(over)
DOH-1555 (02/2004)